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9/21/2018 Annual Report ePermitting Signup - Google Forms <br />https://docs.google.com/forms/d/1lrxOW3YTBhUqGtqfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNjkEM0hceukU5vy5SjhJKGh223uFd…1/3 <br />817 responses <br />Accepting responsesSUMMARYINDIVIDUAL <br />of 817 <br />Responses cannot be edited <br />Annual Repor t ePermitting Signup <br />* Required <br />Please complete this form to create an ePermitting account for submittal of annual reports <br />and fees. You will receive an email with your login information within two business days. <br />Black Range Minerals <br />P.O. Box 98 <br />800 <br />Name of Permittee or NOI Holder: * <br />Street Address: * <br />Annual Report ePermitting Signup <br />QUESTIONS RESPONSES 817